Same day discharge following catheter ablation for atrial fibrillation- a safe and effective approach to patient care
L Pannell, E Duncan, G Thomas, A Nisbet, P BarmanAbstract
Introduction
Many hospitals in Europe routinely admit patients for overnight monitoring following atrial fibrillation (AF) ablation. This contrasts with current UK practice encouraging same day discharge. Although funding differences across countries is contributory, patient safety is a concern. More recently there has been a drive in some countries towards same day discharge. Therefore, a safe and effective protocol is vital.
Purpose
Examine the safety and efficacy of our protocol used for same day discharge of patients following AF ablation in a UK tertiary referral centre.
Methods
Retrospective data analysis was conducted on all elective de-novo and redo AF ablations over a one year period. Relevant baseline characteristics, procedural and post procedural care was collected. Patient safety data included procedural complications and hospitalisation within 30 days.
Results
340 AF ablations were conducted between 1/10/2024 and 30/9/2025. Cryoablation and PFA were most frequently used for de-novo procedures and radiofrequency (RF) ablation for re-do procedures. 44.1% of procedures were conducted under general anaesthesia (GA), and 55.9% under IV sedation with midazolam and fentanyl. All procedures were conducted on therapeutic anticoagulation with additional IV heparin to maintain an activated clotting time (ACT) >300. Heparin was reversed post procedure with IV protamine dependant on operator preference. A Figure of eight suture secured with or without a 3-way stopcock was used for femoral venous vascular compression post procedure, remaining in situ for 4 hours or 1 hour if protamine was administered. No patients had a femoral venous vascular closure device inserted. All patients were monitored on a cardiac day case unit post procedure with regular observations including monitoring of femoral access site. Ambulation was permitted once the suture was removed. Protamine enabled earlier ambulation with no difference in bleeding risk compared to no protamine and no reported allergic reactions. Echocardiograms were not routinely conducted prior to discharge unless there was clinical concern. 89.4% of patients were discharged on the day of procedure, with most overnight stays due to late procedure finish time. 3 patients were admitted for overnight monitoring for minor femoral access site bleeding, not requiring intervention beyond manual pressure. There were no incidences of cardiac perforation or tamponade. There were no reported patient deaths and no readmissions for procedure related complications within 30 days.
Conclusion
Simple post procedural strategies especially regarding venous sheath management enable safe and effective same day discharge for most patients following AF ablation. It is also important to consider morning listing of AF ablation procedures and the long term benefit of dedicated cardiac day case units in hospitals which don’t currently have access, to streamline safe and effective same day discharge.